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Background: Gross taper failure (GTF) is a rare but catastrophic failure mode of the head-stem-taper junction of hip prostheses, facilitated by massive material loss. GTF is a two stage process initiated by corrosion leading to head bottoming out, followed by abrasive wear due to the head rotating on the stem. The purpose of this study was to reproduce the clinical failure patterns and to determine the material loss during simulated gait., Methods: Six cobalt-chromium alloy heads (36 mm, 12/14 taper) with three different head lengths (short / medium / extra long) were combined with stem taper replicas made from titanium alloy sized to achieve bottoming out. A hip simulator was used to simulate gait loading after (ISO 14242-1 for 2 million cycles)., Results: Wear patterns from in-vitro testing match the clinical failure patterns. Stem taper wear increased linearly with time (p< 0.001). After two million cycles the material loss of short / medium / extra long heads was (M+-STD) 1168±242 mg / 400±23 mg / 94±12 mg on the stem side and 46±36 mg / 46±24 mg / 70±8 mg on the head side. Stem taper wear decreased with increasing head length (p=0.01), whereas clinical failures are mostly seen for long and extra long heads., (Copyright © 2021 IPEM. Published by Elsevier Ltd. All rights reserved.)

Contact of implants with high-frequency cauterising instruments has serious implications for patient safety. Studies have reported a possible direct connection of fatigue failure of Ti-6Al-4V implants with electrocautery contact. Such contacts were observed at the polished neck of titanium hip stems, which are subjected to high-tension loads. Evidence of electrocautery contact has also been found on a retrieved spinal fixator with a rough surface; however, no fatigue failure related to electrocautery contact has been reported thus far. The influence of the heat-affected zone caused by flashover on the mechanical behaviour of the Ti-6Al-4V titanium alloy is not yet fully understood. Then, the aim of this study was to investigate whether the polished areas of Ti-6Al-4V implants are especially susceptible to fatigue failure after electrocautery contact. Flashovers caused by electrocautery contact were induced on titanium specimens with different surface roughnesses. These specimens were subjected to cyclic loading in a four-point-bending test setup, which represented the stress resulting from physiological loading activities (~861 MPa). In this test setup, electrocautery contact was found to reduce the fatigue strength of the titanium alloy significantly-by up to 96%-as revealed from the median value of the cycles to failure. Cycles to failure showed a dependence on the flashover duration, with a flashover for 40 ms leading to fatigue fracture. Despite the lower fatigue strength of a rough polished surface in the undamaged state, it is less prone to the damaging effect of flashover than a smooth polished surface., (Copyright © 2020 IPEM. Published by Elsevier Ltd. All rights reserved.)

Deformation of an acetabular cup implant during cementless implantation is indicative of the radial compressive forces, and such of the initial implant fixation strength. Stress relaxation in the surrounding bone tissue following implantation could reduce the deformation of the cup and thus primary implant fixation. The aim of this study was therefore to determine the early shape change of the implanted cup immediately after implantation with different press-fit levels and whether recording the force during cup impaction can be used to estimate initial cup fixation. Cup implantations into porcine acetabulae (n=10) were performed using a drop tower. The force induced by the drop weight and cup seating after each impact was recorded. Deformation of the implanted cup was determined with strain gauges over a period of 10min. Lever-out torques were measured to assess the initial fixation strength. Stress relaxation in the bone caused a reduction in cup deformation of 13.52±4.06% after 1min and 29.34±5.11% after 10min. The fixation strength increased with a higher force magnitude during impaction (R s 2 =0.810, p=0.037). Reduction of the radial compressive forces due to stress relaxation of the surrounding bone should be considered during press-fit cup implantation in order to compensate for the reduced fixation strength over time. In addition, recording the implantation force could help to estimate initial fixation strength., Competing Interests: Conflicts of Interest Michael Morlock is a consultant to DePuy Synthes and serves on speaker bureaus for B Braun Aesculap, AORecon, Ceramtec, Corin, Lima, Mathys, Peter Brehm, DePuySynthes, Zimmer-Biomet., (Copyright © 2020 IPEM. Published by Elsevier Ltd. All rights reserved.)

Fretting corrosion as one reason for failure of modular hip prostheses has been associated with micromotion at the head taper junction. Historically the taper diameter was reduced to improve the range of motion of the hip joint. In combination with other developments, this was accompanied by increased observations of taper fretting, possibly due to the reduced flexural rigidity of smaller tapers. The aim of the study was to investigate how the flexural rigidity of tapers influences the amount of micromotion at the head taper junction. Three different stem and two different taper designs were manufactured. Experimental testing was performed using three different activity levels with peak loads representing walking, stair climbing and stumbling. The relative motion at the head-stem taper was measured in six degrees of freedom. Micromotion was obtained by subtraction of the elastic deformation derived from monoblock and finite element analysis. Less rigid tapers lead to increased micromotion between the head and stem, enlarging the risk of fretting corrosion. The influence of the stem design on micromotion is secondary to taper design. Manufacturers should consider stiffer taper designs to reduce micromotion within the head taper junction., (Copyright © 2019. Published by Elsevier Ltd.)

High rates of clinical complications with bi-modular hip prostheses are attributed to failure of the stem-neck taper junction. Taper wear analyses have shown extensive material loss as a result of corrosion, potentially initiated by micromotion. The purpose of the study was to determine the amount of micromotion at this junction for different loading, assembly and material conditions. Micromotion between the neck adapter (CoCr29Mo6-alloy) and the stem (TiMo12Zr6Fe2-alloy; both Rejuvenate, Stryker) within the taper junction of a bi-modular hip stem were determined by image matching analysis of consecutively recorded images through windows in the stem component. A finite element model was used to determine the micromotion in the taper regions outside the windows and validated with the measured micromotion. With the model, the influence of the load amplitude, assembly force and component materials were then investigated. Determined micromotion (14-79 µm) by far exceeded critical values (5 µm) associated with the onset of fretting corrosion. Increasing assembly forces achieved a significant reduction in micromotion. The numerical model revealed insufficient assembly to cause the neck to perform rocking motions under load, repetitively changing taper contact in combination with gap opening, which facilitates fluid ingress into the junction. Changing the stem material to a stiffer Ti-alloy achieved a reduction of the micromotion of about 30%. This study emphasises the high importance of material selection, assembly force and loading on the susceptibility of bi-modular hip stems to fretting and crevice corrosion. These findings can serve to explain the increased rate of clinically reported problems with this particular prosthesis design., (Copyright © 2019. Published by Elsevier Ltd.)

Stem modularity of revision hip implant systems offers the advantage of the restoration of individual patient geometry but introduces additional interfaces, which are subjected to repetitive bending loading and have a propensity for fretting corrosion. The male stem taper is the weakest part of the modular junction due to its reduced cross section compared to the outside diameter of the stem. Taper fractures can be the consequence of overloading in combination with corrosion. The purpose of this study was to assess the influence of implant design factors, patient factors, and surgical factors on the risk of taper failure of the modular junction of revision stems. An analytical bending model was used to estimate the strength of the taper connection for pristine, fatigued and corroded conditions. Additionally, a finite element contact model of the taper connection was developed to assess the relative motion and potential for surface damage at the taper interface under physiological loading for varyied assembly and design parameters. Increasing the male taper diameter was shown to be the most effective means for increasing taper strength but would require a concurrent increase in the outer implant diameter to limit a greater risk of total surface damage for a thinner female taper wall. Increasing the assembly force decreases the total surface damage but not local magnitudes, which are probably responsible for crack initiation. It is suggested that in unfavourable loading conditions a monobloc implant system will reduce the risk of failure., (Copyright © 2018 IPEM. Published by Elsevier Ltd. All rights reserved.)

Ceramic components are frequently used in total hip replacement due to their good tribological properties. In revision of broken ceramic heads clinical uncertainties arise, whether the taper of the stem can be re-used with a new ceramic head, especially if the stem is well fixed. Ceramic is a brittle material. Even small damage on the male stem taper can lead to stress concentrations causing premature failure of a new ceramic head. As a consequence, manufactures strictly prohibit stem taper re-use for ceramic heads. The aim of this study was to determine the fracture strength of ceramic heads assembled to re-used male stem tapers, which were subjected to prior head fracture. Five 12/14 Ti6Al4V male tapers and 15 Al2O3 ceramic heads (BIOLOX forte(®); ∅ 28 mm, L) were used for three consecutive fracture tests. Before and after every fracture test, all components were inspected visually and the surface geometry was analyzed. Mean fracture force (52.5 kN) did not decrease with the number of taper re-uses (p ≥ 0.77) but the range increased significantly from initially 4.1 kN to 31.8 kN for the first and 52.6 kN for the second re-use due to some components failing at very low loads. Visual inspection was not sufficient to predict the reduced failure loads. Ceramic heads should therefore not be put on used male tapers without metal adapter sleeves., (Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.)

Quantitative computed tomography (QCT)-based finite element (FE) models provide a better prediction of vertebral strength than dual-energy X-ray absorptiometry. However, FE models are often created from datasets acquired at different CT scan protocols and it is unclear whether this influences the FE results. The aim of this paper was to investigate whether there was an effect of the CT scan protocol on the FE models. 12 human thoracolumbar vertebrae were scanned on top of a calcium hydroxyapatite calibration phantom using a standard QCT scan protocol - 120kV, 100mAs (PA); and a low dose protocol - 90kV, 150mAs (PB). FE cancellous models with cuboid volume of interest and inhomogeneous nonlinear bone properties were created. Axial compression was simulated. The apparent BMD, modulus and yield strength showed significant differences between the two scan protocols. The apparent BMD, the modulus and yield strength between the two groups were highly linearly correlated. This paper indicated that the FE models created from image datasets acquired at different X-ray tube voltage settings would give significantly different results and this effect could be possibly corrected using a linear correction approach., (Copyright © 2014 IPEM. Published by Elsevier Ltd. All rights reserved.)

Several bi-modular hip prostheses exhibit an elevated number of fretting-related postoperative complications most probably caused by excessive micromotions at taper connections. This study investigated micromotions at the stem-neck interface of two different designs: one design (Metha, Aesculap AG) has demonstrated a substantial number of in vivo neck fractures for Ti-Ti couplings, but there are no documented fractures for Ti-CoCr couplings. Conversely, for a comparable design (H-Max M, Limacorporate) with a Ti-Ti coupling only one clinical failure has been reported. Prostheses were mechanically tested and the micromotions were recorded using a contactless measurement system. For Ti-Ti couplings, the Metha prosthesis showed a trend towards higher micromotions compared to the H-Max M (6.5 ± 1.6 μm vs. 3.6 ± 1.5 μm, p=0.08). Independent of the design, prostheses with Ti neck adapter caused significantly higher interface micromotions than those with CoCr ones (5.1 ± 2.1 μm vs. 0.8 ± 1.6 μm, p=0.001). No differences in micromotions between the Metha prosthesis with CoCr neck and the H-Max M with Ti neck were observed (2.6 ± 2.0 μm, p=0.25). The material coupling and the design are both crucial for the micromotions magnitude. The extent of micromotions seems to correspond to the number of clinically observed fractures and confirm the relationship between those and the occurrence of fretting corrosion., (Copyright © 2013 IPEM. Published by Elsevier Ltd. All rights reserved.)

Modularity of femoral stems and neck components has become a more frequently used tool for an optimized restoration of the hip joint center and improvement of patient biomechanics. The additional taper interface increases the risk of mechanical failure due to fretting and crevice corrosion. Several failures of titanium alloy neck adapters have been documented in case-reports. An experimental fretting device was developed in this study to systematically investigate the effect of micromotion and contact pressure on fretting damage in contact situations similar to taper interfaces of modular hip prostheses under cyclic loading representative of in vivo load conditions. As a first application, the fretting behavior of Ti-6Al-4V titanium alloy components was investigated. Micromotions were varied between 10μm and 50μm, maximum contact pressures between 400 and 860N/mm(2). All modes of fretting damage were observed: Fretting wear was found for high micromotions in combination with low contact pressures. Fretting fatigue occurred with reduced movement or increased contact pressures. With small micromotions or high normal pressures, low fretting damage was observed. The developed device can be used to evaluate taper design (and especially contact geometry) as well as different materials prior to clinical use., (Copyright © 2012 IPEM. Published by Elsevier Ltd. All rights reserved.)

Some abdominal aortic aneurysms bridged with a minimally invasively introduced stent graft prosthesis increase in size without any diagnosable evidence of endoleakage (endotension). There are three possible pathways proposed through which undetectable low rates of blood flow may cause an aneurysm sac to be refilled: through the thrombus at the prosthesis attachment sites, through the clotted collaterals and through the clotted stent graft wall. If the inflow is more rapid than any drainage through the wall of the aneurysm is re-pressurised. However, critical magnitudes for the permeability of the clotted graft and the geometry of the thrombus at the aneurysm, necessary to inhibit endotension, are not known. The aim of this study was to determine which boundary conditions prevent endotension. An analytical model based on Darcy's Law was used to estimate the pressure in the aneurysm sac due to fluid transfer. Experimentally determined time- and pressure-dependent permeability of red and intraluminal thrombus, and of clotted graft materials were input into the model. The computational analysis showed that endotension is unlikely to be caused by fluid transfer from the collaterals or via the prosthesis attachment sites, but rather due to flow through the stent graft wall. Based on this study it can be stated that grafts with a permeability below 2e-13 mm(2) should diminish the occurrence of endotension., (Copyright © 2010 IPEM. Published by Elsevier Ltd. All rights reserved.)

Hip endoprosthesis systems are analyzed with respect to their susceptibility to self-excited vibrations and sound or noise generation. Experimental studies reveal that certain configurations can become unstable causing exponentially growing regular high-frequency oscillations that asymptotically approach a limit-cycle with considerable amplitude. Ultimately the vibrations do also lead to the emission of sound that is perceived as squeaking or squeal. To identify dominant influence factors and critical parameters, stability analyses were conducted on the basis of finite-element modeling. The resulting numerical approach, based on the determination of complex eigenvalues and eigenvectors, is shown to be an effective tool to analyze and show differences between endoprosthesis designs with respect to their susceptibility to develop squeaking phenomenons., (Copyright 2010 IPEM. Published by Elsevier Ltd. All rights reserved.)

Primary stability is essential to the success of uncemented prostheses. It is strongly influenced by implantation technique, implant design and bone quality. The goal of this study was to investigate the effect of press-fit parameters on the primary stability of uncemented femoral head resurfacing prostheses. An in vitro study with human specimens and prototype implants (nominal radial interference 170 and 420 microm) was used to investigate the effect of interference on primary stability. A finite element model was used to assess the influence of interference, friction between implant and bone, and bone quality. Primary stability was represented by the torque capacity of the implant. The model predicted increasing stability with actual interference, bone quality and friction coefficient; plastic deformation of the bone began at interferences of less than 100 microm. Experimentally, however, stability was not related to interference. This may be due to abrasion or the collapse of trabecular bone structures at higher interferences, which could not be captured by the model. High nominal interferences as tested experimentally appear unlikely to result in improved stability clinically. An implantation force of about 2,500 N was estimated to be sufficient to achieve a torque capacity of about 30 N m with a small interference (70 microm).

Modern hip joint replacements are designed to minimise wear problems. The most popular metal-on-polyethylene components are being updated by harder metal and ceramic combinations. However, this has also been shown to influence the friction moments, which could overload the interface between the implant and the body. In this study custom test apparatus was used to measure the joint moments in various modern bearings under simulated physiological joint conditions. The largest moments in serum were measured for large diameter metal-metal bearings (<8 Nm for standard bearings), followed by metal-polyethylene, and the lowest moments were for small diameter ceramic-ceramic and ceramic-metal combinations. Water as a lubricant was found to double the moments in comparison with serum. In metal-metal bearings moments were reduced by increasing loading frequency. Swing phase load and a rest period between load cycles had little effect. The moment magnitudes are within the turn-out capacity measured for press-fit cups and might become critical with higher joint loads.

Spinal specimens are commonly sprayed with saline solution during mechanical testing to ensure adequate hydration. However, potting of vertebrae inhibits physiological fluid exchange through the porous endplates during loading. This un-physiological flow regime may influence mechanical properties of intervertebral discs and therefore of the whole spinal unit. The objective of this study was to evaluate a new method of spinal specimen hydration through the vertebral body during in vitro testing in order to improve consistency of mechanical behaviour. Ovine lumbar anterior column units were prepared for testing. Half of the specimens were sprayed with Ringer's solution and wrapped in plastic foil. The remainder received an additional saline infusion into the centre of each vertebral body. Three consecutive compression steps were applied by a hydraulic testing machine. Average forces within four sectors of the relaxation curves were compared. Applying saline infusion improves the consistency of consecutive relaxation curves. Differences between consecutive relaxation curves were less than those for standard hydration. The forces at the beginning of the relaxation curve were also lower for the infusion method. The standard deviation between specimens of each group was lower for saline infusion of vertebrae. Hence, the new method leads to more consistent in vitro testing conditions.